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May 14, 2024

If you're considering offering dental implants in your clinic, you might be wondering:

  • What’s guided dental implant surgery? 
  • What’s non-guided dental implant surgery? 
  • What’'s the difference?
  • And which is better for you and your practice? 

In this blog, we’ll cover the two approaches you can take when placing dental implants and answer any questions you have on what you need to know to prepare yourself better for dental implant surgery.

What is Guided Dental Implant Surgery?

This uses 3D imaging and planning software and a printed surgical guide to provide the dentist with a virtual map of where to place the implants. 

This type of dental implant surgery typically allows for minimal drilling and is considered minimally invasive.

You can watch our 3D Printing Workflow guide on how to 3D print surgical guides to use in your dental surgery below:

What is Non-Guided Dental Implant Surgery?

Also known as freehand surgery, this depends solely on the dentist's clinical experience, eyeballing, and judgment to determine the implant positions while the patient is in the chair. 

In contrast to guided dental implant surgery, more invasive drilling is typically used when implementing this surgery method.

So, Which Type of Implant Surgery is Better - Guided or Non-Guided? 

Well, like most things in dentistry. It depends on your patient, where each case is unique to the next.

Accuracy

Guided dental implant surgery enables implants to be positioned based on detailed 3D planning and within 2mm of accuracy

This level of precision is nearly impossible to match freehand, so guided surgery usually allows for more accurately placed implants compared to lower accuracy rates of non-guided surgery.

One study even cited that guided implant surgery “should be considered the gold standard approach.

The lack of a surgical guide, during non-guided implant surgery, may make it more challenging to achieve optimal implant angulation and alignment, which can impact the long-term success of the implant and the aesthetics of the final restoration.

Success Rate

Some research shows that guided surgery can have higher long-term implant survival rates than non-guided placement. 

One found the incidence of implant failure in guided surgery to be 2.25% vs 6.42%, indicating a higher survival rate than that of non-guided surgery. Furthermore, non-guided implant surgery demonstrated implant failure rates almost three times higher than guided implant surgery.

The precision possible with guided surgery may prevent complications and positively impact the implant’s survival rate.

Patient Comfort

Guided surgery is often less invasive because there is no need to flap open the gums to visualize the bone. No sutures are required post-surgery, and the patient usually has less swelling, bleeding, and recovery time with guided surgery.

Bone Grafting Requirements

The detailed 3D planning that occurs during guided implant surgery can allow the dental team to properly assess bone thickness and density at the planned implant sites. This information can help reduce the need for bone grafting procedures to augment the jawbone before placement.

Non-guided implant surgery may be the only option in certain cases where there is insufficient bone density or anatomical limitations that prevent the use of a surgical guide. 

Aesthetic Results

With the pinpoint accuracy of guided surgery, implants can sometimes be immediately restored with aesthetically pleasing temporary teeth. The predictability can also allow for longer-lasting, better functioning, and more natural-looking final implant crowns down the road.

Cost

Non-guided dental implant surgery is generally less expensive than guided implant surgery.

On average, guided surgery usually costs more than non-guided surgery- approximately $500 to $1500 per implant. This is because guided surgery covers the pre-operative CT scan, 3D planning software, and surgical guide production. 

For a restorative-driven workflow, a digital tooth mock-up is used to help find the most aesthetic and functional implant position. CBCT data help you account for bone density, sinus, or inferior alveolar nerve.

The surgical guide design is very straightforward and fully customizable, windows are added to help assess proper seating in the patient’s mouth.

However, reductions in anesthesia fees, treatment time, and other simplifications can balance out some of these costs over time.

When choosing which surgery approach is best, this is something to consider and discuss with your patient.

Treatment Time

Guided surgery appointments are often shorter in comparison to non-guided surgical appointments.

While the upfront planning does take time, guided surgery enables the dentist to work more swiftly and decisively once the patient is in the chair for surgery. They can continue bone quality and density analyses along the way as this is done pre-emptively. 

Dentist Skill Level

Guided implant surgery allows dentists to get exceptionally reliable guidance, even if they are not the most experienced implant specialists. Still, a seasonally skilled and inexperienced dentist can benefit from this approach.

Non-guided implant surgery relies heavily on the surgeon's skill and experience, which may lead to less precise implant positioning compared to guided surgery. There are also risk of complications, such as implant misalignment or damage to adjacent teeth or nerves, may be higher with non-guided surgery.

TL;DR

Both methods of dental implant surgery work. Again, this is all down to personal preference of both the dentist and the patient.

For this reason, it is essential that dentists and clinicians communicate effectively and clearly to their patients to decide what treatment is best for them. 

So, let’s summarize the pros and cons of each method:

Guided Dental Implant Surgery

  • Higher long-term success rates reported in studies
  • Ideal positioning based on anatomy and restorative plan
  • Optimized angulation to compensate for bone deficiencies
  • Minimized risk of nerve damage or other complications
  • Reduced possibility of needing bone grafts or sinus lifts
  • Shorter, more efficient surgery time
  • Facilitates an immediate temporary prosthetic in many cases
  • Requires additional CT scan and technology
  • More upfront planning and expense
  • Longer overall treatment time
  • Limited adjustment ability after surgery

Non-Guided Dental Implant Surgery

  • Offers more flexibility for real-time adjustments during surgery
  • May be suitable for simple cases
  • Generally less expensive than guided implant surgery - less materials
  • Shorter planning time - no need for creation of a surgical guide
  • May be associated with a higher risk of errors, especially for less experienced dentists or in complex cases
  • Requires manual determination of implant position, angle, and depth during surgery
  • Relies on dentist's clinical judgement and experience
  • May require a longer healing time and more extensive bone grafting procedures, especially if the implant is not placed optimally

Conclusion

For most patients, guided implant surgery offers significant advantages, making it the preferred technique for the dentist and patient. 

However, non-guided surgery still has its place and should not be disregarded as an option. 

For some patients, the extra upfront costs of guided surgery may not be feasible. 

Others may require bone grafting regardless of the technique used. In some scenarios, very skilled dentists can still achieve great outcomes with freehand implant placement.

As previously stated, every case is unique. With this in mind, be sure to have an open discussion with your patient about which option is right for their particular situation. 

Consider accuracy, comfort, recovery time, aesthetics, and costs that matter most to the patient. 

However, for many patients, guided surgery is positioning itself as the way of the future in the implant dentistry world.


Want to learn more about guided surgery? 

Join iDD’s Free Academy and gain instant access to one of our online courses below:

About the author 

Dr Ahmad Al-Hassiny

Dr Ahmad is a global leader in digital dentistry and intraoral scanners, carrying out lectures as a KOL for many companies and industry. He is one of the few in the world who owns and has tested all mainstream scanners and CAD/CAM systems in his clinic. Dr Ahmad Al-Hassiny is a full-time private dentist in New Zealand and the Director of The Institute of Digital Dentistry (iDD), a world-leading digital dentistry education provider. iDD offers live courses, masterclasses, and an online training platform, with a mission to ensure dentists globally have easy and affordable access to the best digital dentistry training possible.

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